Healthcare Provider Details

I. General information

NPI: 1376451807
Provider Name (Legal Business Name): KALLE STIDHAM D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N JACKSON AVE STE 205
SAN JOSE CA
95116-1915
US

IV. Provider business mailing address

125 N JACKSON AVE STE 205
SAN JOSE CA
95116-1915
US

V. Phone/Fax

Practice location:
  • Phone: 408-929-5610
  • Fax:
Mailing address:
  • Phone: 408-258-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KALLE STIDHAM
Title or Position: ORTHOPEDIC SURGEON
Credential: DO
Phone: 650-319-5771